Should problem based learning be universally adopted? Yes

Application of knowledge

In medical care we apply our learning in a particular context, such as in the emergency department or in a primary care practice.5 Unlike a lecture, PBL is designed to frame knowledge and understanding within a clinical problem. Students and doctors are stimulated to find out what they need to know to solve the case and to understand that they should take responsibility for their learning, which mimics how we approach clinical situations. Users of PBL often find that learning is more satisfying (and immediately applicable) with increasing authenticity of cases—using real patients or employing PBL in clinical attachments.67

Collaborative learning

PBL is also designed to encourage collaborative learning,25 and good team work is closely related to high quality healthcare. In a well functioning PBL group, each member appreciates that in explaining things to others and, in turn, listening, the team is more efficient and powerful than the individual in getting to grips with a clinical problem. In addition, important skills, such as leading a group, are developed and tested out.

Motivation for learning

It is also important during a medical career to maintain motivation and to have the skill set for ongoing learning in postgraduate education. Most forms of PBL involve group meetings to determine the areas for study and then meeting again to share learning and, importantly, the resources used. This model is unlike the traditional approach of an expert transmitting distilled knowledge to students in an essentially passive process, such as a lecture. We all require an essential skill set for lifelong learning so that we can determine what we need to know; identify appropriate resources—that is, journals, internet, experts; appraise the value of these resources; and use the understanding gained within clinical practice. All of these skills are fostered by PBL.

Facilitating transfer of knowledge

The final, most important, area that is cultivated by PBL is the ability to transfer knowledge from one context to the next—for example, patients. This is central to clinical expertise and is the area that students who are taught via more traditional forms of teaching are most criticised for; when they are tested in examinations they perform well, but are unable to translate knowledge to the clinic. The ability to transfer between settings is built up over years, but can be promoted by learning through multiple problems, all focused on the same themes. For example, students can gain insight into the myriad ways that strokes manifest by discussing presentations of different patients of varying ages and backgrounds in several, short PBL vignettes. The end result would demonstrate that the common link is impairment of the blood supply to the brain. This “compare and contrast” active learning is a more effective approach, which promotes a deeper understanding than simply being told about the blood supply in a lecture.5

As with general practitioners, the continuing education of consultants based on lectures and courses is now being questioned given the costs and the passive nature of the learning. PBL is not necessarily more expensive, and, several years ago a literature review of PBL in continuing medical education concluded that there was evidence of greater satisfaction compared with traditional approaches.89 A subsequent study looking at postgraduate training of occupational physicians found that PBL was more effective than lectures in improving performance.10

Recently, Prober and Heath argued that medical education has changed little over the past 100 years, and there is a great need to adopt teaching methods based on educational research and development of new learning tools.11 The use of online resources is growing exponentially and the adoption of small group discussions within continuing medical education courses is now encouraged. This blend of group learning and online resources that focus on clinical problems (often brought by the participants) is essentially PBL. If we look at the underlying principles and evidence, PBL should be universally adopted as being an efficient and effective learning method across the undergraduate and postgraduate medical education spectrum.